Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT208153 | PA |
Y | 2080P0216X | Pediatric Rheumatologist | MT208153 | PA |
NPI | 1467832337 |
---|---|
Provider Name | Beth Haneman Rutstein |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 26/06/2018 |